Predicting factors for success of vaginal delivery in preterm induction with prostaglandin E2
3
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: To evaluate the efficacy and safety of prostaglandin (PG) E2 for preterm labor induction and to investigate the predictive factors for the success of vaginal delivery. Methods: A retrospective cohort study was performed in women (n=155) at 24+0 to 36+6 weeks of gestation who underwent induction of labor using a PGE2 vaginal pessary (10 mg, Propess) from January 2009 to December 2015. Success rates of vaginal delivery according to gestational age at induction and incidence of intrapartum complications such as tachysystole and nonreassuring fetal heart rate were investigated. Multivariable logistic regression analysis was performed to evaluate the predictive factors for success of labor induction. Results: The vaginal delivery rate was 57% (n=89) and the rate of cesarean delivery after induction was 43% (n=66). According to gestational age, labor induction was successful in 16.7%, 50.0%, and 62.8% of patients at 24 to 31, 32 to 33, and 34 to 36 weeks, showing a stepwise increase (P=0.006). There were 18 cases (11%) of fetal distress, 9 cases (5.8%) of tachysystole, and 6 cases (3.8%) of massive postpartum bleeding (>1,000 mL). After adjusting for confounding factors, multiparity (odds ratio [OR], 8.47; 95% confidence interval [CI], 3.10 to 23.14), younger maternal age (OR, 0.84; 95% CI, 0.75 to 0.94), advanced gestational age at induction (OR, 1.06; 95% CI, 1.02 to 1.09), rupture of membranes (OR, 11.83; 95% CI, 3.55 to 39.40), and the Bishop score change after removal of PGE2 (OR, 2.19; 95% CI, 1.0 to 4.8) were significant predictors of successful preterm vaginal delivery. Conclusion: An understanding of the principal predictive factors of successful preterm labor induction, as well as the safety of PGE2, will provide useful information when clinicians consult with preterm pregnant women requiring premature delivery.
Abstract
Objective: To evaluate the efficacy and safety of prostaglandin (PG) E2 for preterm labor induction and to investigate the predictive factors for the success of vaginal delivery. Methods: A retrospective cohort study was performed in women (n=155) at 24+0 to 36+6 weeks of gestation who underwent induction of labor using a PGE2 vaginal pessary (10 mg, Propess) from January 2009 to December 2015. Success rates of vaginal delivery according to gestational age at induction and incidence of intrapartum complications such as tachysystole and nonreassuring fetal heart rate were investigated. Multivariable logistic regression analysis was performed to evaluate the predictive factors for success of labor induction. Results: The vaginal delivery rate was 57% (n=89) and the rate of cesarean delivery after induction was 43% (n=66). According to gestational age, labor induction was successful in 16.7%, 50.0%, and 62.8% of patients at 24 to 31, 32 to 33, and 34 to 36 weeks, showing a stepwise increase (P=0.006). There were 18 cases (11%) of fetal distress, 9 cases (5.8%) of tachysystole, and 6 cases (3.8%) of massive postpartum bleeding (>1,000 mL). After adjusting for confounding factors, multiparity (odds ratio [OR], 8.47; 95% confidence interval [CI], 3.10 to 23.14), younger maternal age (OR, 0.84; 95% CI, 0.75 to 0.94), advanced gestational age at induction (OR, 1.06; 95% CI, 1.02 to 1.09), rupture of membranes (OR, 11.83; 95% CI, 3.55 to 39.40), and the Bishop score change after removal of PGE2 (OR, 2.19; 95% CI, 1.0 to 4.8) were significant predictors of successful preterm vaginal delivery. Conclusion: An understanding of the principal predictive factors of successful preterm labor induction, as well as the safety of PGE2, will provide useful information when clinicians consult with preterm pregnant women requiring premature delivery.
참고문헌 (20)
- Vrouenraets FP, "Bishop score and risk of cesarean delivery after induction of labor in nulliparous women", Obstet Gynecol, 105, pp.690~697 (2005)
- Hendricks CH, "Normal cervical dilatation pattern in late pregnancy and labor", Am J Obstet Gynecol, 106, pp.1065~1082 (1970)
- ACOG Committee on Practice Bulletins Obstetrics, "ACOG Practice Bulletin No. 107: Induction of labor", Obstet Gynecol, 114, pp.386~397 (2009)
- 민정애, "지연 임신의 임상 현황에 대한 국내 조사", Obstetrics & Gynecology Science, 50(1), pp.79~84 (2007), 대한산부인과학회
- Kelly AJ, "Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term", Cochrane Database Syst Rev, 4, pp.CD003101~ (2003)
- Abelin Tornblom S, "Pre-term cervical ripening and labor induction", Eur J Obstet Gynecol Reprod Biol, 104, pp.120~123 (2002)
- Carlan SJ, "Serial intravaginal prostaglandin E2 gel cervical ripening in preterm pregnancies", Prostaglandins, 52, pp.237~246 (1996)
- Moore LE, "Elective induction of labor", Clin Obstet Gynecol, 49, pp.698~704 (2006)
- Hofmeyr GJ, "Vaginal misoprostol for cervical ripening and induction of labour", Cochrane Database Syst Rev, 1, pp.CD000941~ (2003)
- Ray DA, "Prostaglandin E2 for induction of labor in patients with premature rupture of membranes at term", Am J Obstet Gynecol, 166, pp.836~843 (1992)
- Ben-Haroush A, "Mode of delivery in pregnancies with premature rupture of membranes at or before term following induction of labor with vaginal prostaglandin E2", Am J Perinatol, 21, pp.263~268 (2004)
- Melamed N, "Preinduction cervical ripening with prostaglandin E2 at preterm", Acta Obstet Gynecol Scand, 87, pp.63~67 (2008)
- Ehrenthal DB, "Labor induction and the risk of a cesarean delivery among nulliparous women at term", Obstet Gynecol, 116, pp.35~42 (2010)
- Johnson DP, "Risk of cesarean delivery after induction at term in nulliparous women with an unfavorable cervix", Am J Obstet Gynecol, 188, pp.1565~1569 (2003)
- Anderson AB, "Relationship between length of gestation and cervical dilatation, uterine contractility, and other factors during pregnancy", Am J Obstet Gynecol, 105, pp.1207~1214 (1969)
- Yogev Y, "Induction of labor with vaginal prostaglandin E2", J Matern Fetal Neonatal Med, 14, pp.30~34 (2003)
- Prysak M, "Elective induction versus spontaneous labor: a case-control analysis of safety and efficacy", Obstet Gynecol, 92, pp.47~52 (1998)
- 이혜란, "Risk of cesarean section after induced versus spontaneous labor at term gestation", Obstetrics & Gynecology Science, 58(5), pp.346~352 (2015), 대한산부인과학회[DOI]
- Nageotte MP, "Quantitation of uterine activity preceding preterm, term, and postterm labor", Am J Obstet Gynecol, 158, pp.1254~1259 (1988)
- Blackwell SC, "Labor induction for the preterm severe pre-eclamptic patient: is it worth the effort?", J Matern Fetal Med, 10, pp.305~311 (2001)